More have bowel disease that can raise cancer risk

NUS student Waise Koh (left), 23, was diagnosed with the intestinal condition at the age of 18. He is seen here with SGH consultant Shim Hang Hock. Mr Koh is now better after treatment.
NUS student Waise Koh (left), 23, was diagnosed with the intestinal condition at the age of 18. He is seen here with SGH consultant Shim Hang Hock. Mr Koh is now better after treatment.ST PHOTO: NG SOR LUAN

More Singaporeans are being diagnosed with an intestinal condition that puts them at higher risk of colon cancer.

Statistics by several hospitals in Singapore show that inflammatory bowel disease (IBD) has been on the rise in the last decade.

People with this chronic condition suffer from inflammation of the intestine. They may then experience symptoms such as diarrhoea, fever, abdominal pain and cramping, blood in stools, reduced appetite and unintended weight loss.

Singapore General Hospital (SGH) saw close to 600 patients diagnosed with the disease last year, a twofold increase from 2007.

At National University Hospital (NUH), the number has jumped by eight times, from below 50 in 2013 to close to 400 cases this year.

"The reasons as to why there is this large increase is still not known," said Dr David Ong, head at NUH's division of gastroenterology and hepatology.

  • Warning signs can be mistaken

  • The warning signs of inflammatory bowel disease (IBD) are subtle and are commonly mistaken as irritable bowel syndrome (IBS), a completely different condition which does not result in inflammation of the intestine.

    Symptoms of IBS include poor appetite, bloating, abdominal pain and diarrhoea that may or may not be bloody.

    "Due to the lack of awareness about IBD and symptoms mistaken as IBS, the condition often goes undetected and as a result, diagnosis is delayed," said Dr Shim Hang Hock, consultant at Singapore General Hospital's department of gastroenterology and hepatology.

    "Anti-inflammatory drugs are usually given as an initial treatment and is sufficient for most patients. Depending on the severity and extent of the problem, other medication to suppress the immune system may also be given," he added.

    Unfortunately, there are no precautions that people can take to prevent IBD from happening since the exact cause is unknown.

    "However, one should not smoke, but take a nutritious diet with lots of green and fruits," said Dr Amitabh Monga, a specialist in gastroenterology at Raffles Internal Medicine Centre.

    Dr Christina Ong, head and senior consultant in gastroenterology service in the department of paediatrics at KK Women's and Children's Hospital, added: "The best advice to patients, apart from leading a healthy lifestyle, is to be compliant to medications which have been prescribed to control IBD, to attend medical appointments as regular blood tests may be necessary, and to seek medical attention early when unwell."

    Dr Shim noted that if IBD symptoms are neglected, it may raise the risk of colon cancer, surgery and hospitalisation. "We have seen cases that were presented late and have to be treated with surgery," he added. Jasia Shamdasani

The disease is most common among those between 20 and 40 years old, but in rare cases can also occur even in a one-year-old child.

IBD is a collective term for two conditions: Crohn's disease, which can affect any part from the mouth to the large intestine, and ulcerative colitis, which only affects the large intestine.

"Having IBD in the long term can increase one's risk of getting colon cancer," said Dr Ong.

"It was once considered to be a Western disease, but is now more prevalent in Asia, including Singapore," said Dr Shim Hang Hock, consultant at SGH's department of gastroenterology and hepatology.

Dr Malcolm Tan, consultant in the gastroenterology and hepatology department at Changi General Hospital, said: "As Singapore modernises, the food that we eat would more closely resemble that of Western countries. The number of new patients diagnosed with IBD would go up in time, as we are already seeing in Singapore."

But Dr Shim thinks a change of diet alone cannot explain the spike.

"Given the rapid rise that we are seeing, it has to be something environmental, but exactly what, it is still being researched," he said.

Many postulations, including the role of one's hygiene, antibiotic exposure in early childhood, a Westernised diet and smoking, have not proven to cause the disease on their own, he added.

But Dr Shim said IBD is believed "to be due to a disturbance of the immune balance, possibly triggered by environmental factors, or bacteria in the gut, in a person who is genetically at risk".

There is no cure for the condition, said Dr Christina Ong, who heads the gastroenterology service in the department of paediatrics at KK Women's and Children's Hospital.

"However, the aim is to get the disease under control for as long as possible so that patients can lead a normal life, including going to school, participating in sports and going on family vacations," she added.

Mr Waise Koh was 18 years old when he was diagnosed with ulcerative colitis while preparing for his A-level examinations in 2013.

At first, he thought that his diarrhoea was due to food poisoning. But alarm bells rang when he passed bloody stools more than 20 times daily for a month.

Now 23, the National University Singapore (NUS) computational biology student said he visited a hospital where he was diagnosed with IBD. By then, Mr Koh had already shed more than 10kg.

Mr Koh was put on medication and now experiences symptoms like diarrhoea only occasionally.

"Its getting better now. The last time I experienced the symptoms was last year, in November," said Mr Koh.

A version of this article appeared in the print edition of The Straits Times on May 30, 2018, with the headline 'More have bowel disease that can raise cancer risk'. Print Edition | Subscribe